Active NPI
Adam Deforest Wilson, PH.D.
- Clinical Psychologist
- San Mateo, CA
National Provider Identifier
1619756145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY34482
- Practice address
- 10 Beresford CT
San Mateo, CA 94403-4597 - Phone
- (607) 379-4305
- NPI assigned
- Sep 25, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY34482 | CA | Primary |
Addresses
Primary practice location
10 Beresford CT
San Mateo, CA 94403-4597
Mailing address
1201 Milton St
Pittsburgh, PA 15218-1232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34482 | CA | MD | Clinical Psychologist |
| 34482 | CA | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PC | Clinical | Current | Accepting new patients |
Locations
99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1619756145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 MILTON ST",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152181232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 BERESFORD CT",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944034597",
"telephone_number": "607-379-4305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ADAM",
"middle_name": "DEFOREST",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-25",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY34482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.